International Conference on Science and Technology for Sustainability 2007 ility 2007 International Conference on Science and Technology for Sustainab International Cooperation for Development International Cooperation for Development Infectious Diseases: Surveillance and Control Infectious Diseases: Surveillance and Control Emerging and Re- -emerging Infectious Diseases emerging Infectious Diseases Emerging and Re Nobuhiko OKABE, MD, PhD Nobuhiko OKABE, MD, PhD Infectious Disease Surveillance Center Center Infectious Disease Surveillance National Institute of Infectious Diseases, Japan National Institute of Infectious Diseases, Japan Sept 15 Sept 15, , 2007 2007, , Tokyo Tokyo
Infectious disease is caused by transmission of micro- - Infectious disease is caused by transmission of micro organisms. organisms. It is spread widely among human, if nothing taken. It is spread widely among human, if nothing taken. Prevention of Infectious Diseases Prevention of Infectious Diseases � not contact with infected patients (isolation) � to clean materials contaminated (disinfection) to keep healthy and clean condition � to give immunity (vaccination), if available �
isolation isolation disinfection disinfection
Immunization was introduced at 1796. Immunization was introduced at 1796. Small pox (variolla)
鍋島邸（佐賀藩）における わが国初めての種痘 1849 Ｉｎｔｒｏｄｕｃｅｄ Ｉｍｍｕｎｉｚａｔｉｏｎ first in Japan (Saga Han, Kyushu) at 1849
Measles in Japan Measles in Japan at 1800`s at 1800`s Every 20- -40 years, big 40 years, big Every 20 outbreak of measles outbreak of measles occurred occurred Many people both young Many people both young children and adults were children and adults were suffered by this fatal suffered by this fatal disease disease The could only prayed The could only prayed not to be suffered by not to be suffered by measles measles
Number of Reported Polio by Year in Japan (1947- -2006) 2006) Number of Reported Polio by Year in Japan (1947 6000 Urgent introduction of OPV imported from USSR and Canada 4000 2000 Legal use of OPV as a routine immunization with 2 doses 1964- with 2 doses 0 1950 1960 1970 1980 1990
Last case of wild- -polio in the Region polio in the Region Last case of wild Americas Region Luis Fermin Tenorio Peru 1991 Western Pacific Region Mum Chanty Cambodia 1997 European Region Melik Minas Turkey 1998 Polio Eradication
A region where no children suffer from …… Polio Neonatal Hepatitis B Tetanus Measles and diphtheria, pertussis & infant tuberculosis
WHO Regional Measles WHO Regional Measles Elimination Targets Elimination Targets 2 0 0 7 2 0 0 7 2 0 1 0 2 0 1 0 2 0 0 0 2 0 0 0 2012 2012
WHO- -facilitated outbreak responses facilitated outbreak responses WHO in the field, 1998 – 2003 in the field, 1998 – 2003 Microbes are unpredictable! June 4, 2003 World Health Organization World Health Organization June 4, 2003 World Health Organization World Health Organization
� Emerging Infectious Diseases EID are those due to newly identified and previously unknown infections which cause public health problems either locally or Internationally. � Re-emerging Infectious Diseases REID are those due to the reappearance and increase of infections which are known, but had formerly fallen to levels so low that they were no longer considered a public health problem.
The HIV/AIDS pandemic A new virus recognized A new virus recognized in the early 1980s in the early 1980s July 2007 July 2007 • 39.5 M HIV infected • 39.5 M HIV infected • 2.9 M deaths in 2006 • 2.9 M deaths in 2006 • Drug-Resistance • Drug-Resistance • No vaccine • No vaccine
ＳＡＲＳ ｉｎ ２００３ Index case: Index case: from Guandon, China from Guandon, China Canada Canada Irland Irland USA USA Hotel M Hanoi Hanoi Germany Germany Bangkok Bangkok Singapore Singapore
2005. Marburg disease In Angola 374 （ death 328: FTR 88%)
The malaria challenge The malaria challenge 2.0 Annual deaths from malaria (millions) World 1.0 Africa 0 1950 1970 1990 2000 ( R.Carter,1999 )
Anti- -malarial drug resistance to malarial drug resistance to Anti treatment worldwide, 2001 treatment worldwide, 2001 Chloroquine Chloroquine resistance resistance S/ P resistance S/ P resistance Multi Multi- -drug resistance drug resistance
Multidrug- -resistant TB (MDR resistant TB (MDR- -TB), 2001 TB), 2001 Multidrug hyperendemic outbreaks Cost of treating multidrug-resistant TB: � US$ 250 000 per patient in industrialized countries, � US$ 1 000 –$ 10 000 in developing countries
Dengue/Dengue fever Dengue/Dengue fever Dengue/Dengue fever Average annual number of DF/DHF cases reported to WHO 1,000,000 877,888 800,000 600,000 492,820 400,000 295,591 122,174 200,000 15,547 454 0 1950s 1960s 1970s 1980s 1990s 2000s* * 2000-2003, provisional data
DF/DHF DF/DHF DF/DHF 1950-1969 1970-1979 1980-1999 1996 reported 1999 reported 1998 reported 2000> 2004 reported 2005 reported
Leading causes of mortality, 2001 Leading causes of mortality, 2001 Total = 53.9 million Total = 53.9 million Low-income nations Premature mortality (South-East Asia & Africa) (worldwide, 0–44 years) 3% 2% 2% 1% 10% 6% 11% 48% 19% 45% 18% 35% Non-communicable Injuries Infectious Perinatal Maternal Nutritional
Leading infectious causes of Leading infectious causes of mortality, 2001 estimates mortality, 2001 estimates 3.5 3.5 < 5 years old > 5 years old 3.0 2.3 2.2 2.5 Deaths (millions) 2.0 1.5 1.5 1.1 0.9 1.0 0.5 0 ARI AIDS Diarrhoea TB Malaria Measles
Why infectious disease, again. Why infectious disease, again. A Changing World ! A Changing World ! � Collapse of public health Collapse of public health � infrastructure infrastructure � Poverty, urbanisation and Poverty, urbanisation and � population displacement population displacement � Environmental exploitation Environmental exploitation � and degradation and degradation � Complex and natural Complex and natural � disasters disasters
A Changing World ! A Changing World ! � Development of antimicrobial Development of antimicrobial � resistance resistance � Animal diseases crossing into Animal diseases crossing into � human populations human populations � Globalisation of travel and trade Globalisation of travel and trade � (great benefits but new threats !) (great benefits but new threats !) � Inappropriate social, political and Inappropriate social, political and � economic responses to economic responses to outbreaks outbreaks
Additoinal Situation on Infectious Diseases: Bioterolism Fungal infections Bacterial � Coccidioidomycosis infections � Plague � Anthrax � Tularaemia Ricketsial infections � Typhus � Rocky Mountain Virus infections spotted fever � Arbovirus � Filoviruws � Small pox
Infectious Diseases Control Infectious Diseases Control � Prevention Hygiene (personal, public) Immunization � Diagnosis Clinical Diagnosis Microbiological Diagnosis � Treatment � Surveillance
First Late Delayed Case Detection Response 90 80 70 60 CASES Opportunity 50 40 for control 30 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 DAY
Early Rapid Detection Response 90 80 Opportunity 70 for Control 60 CASES 50 40 30 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 DAY
Backbone of Surveillance Backbone of Surveillance � To collect information � To analysis information � To disseminate information - regularly, timely and rapidly
� Infectious diseases do not respect international borders. � Global and regional partnerships and the rapid sharing of data and other information enhance preparedness and evidence-based control strategies. � Strengthening surveillance system and networks is recognized as one of the most important tool to dissolve these issues. It is necessary to improve and to strengthen surveillance with regard to health crises. � It is necessary to keep track of outbreak trends of basic infectious diseases on a daily basis, and to detect any abnormalities as early as possible.
� Furthermore, it is necessary to pass on this information in an appropriate and easy-to-understand manner and to enhance provision of information. � Sometimes crises caused by false rumors and misinformation result in more direct damage ． � Fair disclosure of information and easy-to-understand explanations provided to public from a scientific standpoint are increasingly required as measures to manage health crises.
Response to Outbreak of Infectious Diseases through Information Network MHW Pr e f . De p . He a l t h Ja p . Me d . A s s . Lo c a l Co m m i t t e e Pu b l i c He a l t h I n s t . Ce n t r a l Co m m i t t e e Lo c a l Me d . A s s . Pu b l i c He a l t h Ct r . NI I D F ie ld E p id e m i o lo g is t Cl i n i c / Ho s p i t a l W HO, CDC, PHLS, e t c Qu a r a n t i n e St . Co m m u n i t y
Global health protection - - Global health protection the challenges the challenges
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